Process for Referring Individuals to State Plan Personal Care
March 2014
*Support Coordinator will work with the individual/family to identify needs and discuss the process of referring to DHSS for state plan services prior to accessing waiver services. This will ensure that the individual/family is aware that a referral is being made to DHSS.
* Support Coordinator documents in the ISP the personal assistance needs of the individual.
* The plan must clarify whether PA is for hands on assistance (state plan) versus cueing/ prompting/training (DD) and whether the service is to be performed in the home only (state plan) versus in the community (DD).
Support Coordinator documents in the ISP:
____Referred to DHSS for state plan personal care
____Not referred to DHSS for state plan personal care because:______
*If the services are appropriate via state plan, the request is sent by the support coordinator to the Call Center at 866-835-3505 (for adults), and 573-751-6246 (for children). The Call Center will pre-screen the referral. If appropriate, they will assign to staffto complete the assessment.
* When making a referral to DHSS, you will need a signed release to obtain information regarding whether the individual is also in a managed care program.
* If a child is already receiving Private Duty Nursing services through Healthy Children and Youth there is no need to refer the child to Bureau of Special Health Care Needs for State Plan Personal Care services. If Personal Care services were appropriate for the child, they would be authorized for Personal Care.
* If DHSS approves eligibility, the ISP must document the hours of personal careservices provided through DHSS.
* Support Coordinator will explain to families that they cannot start DHSS services just to access waiver services, and then stop DHSS services because they are getting DD waiver services.
* If DHSS denies eligibility, documentation of the denial should be submitted with the plan to UR. Documentation may include either a copy of the adverse action letter to the participant, or documentation of a phone call between the support coordinator and DHSS validating the denial. Phone call documentation must include the date, and the name of the individual validating the denial.
* UR reviews the ISP to verify state plan services have been accessed if appropriate. Partnership for Hope WaiverISPs and referral documentation will be reviewed by the Director/Designee.